Brett Schrewe

Through a humanities lens, Brett Schrewe searches for synergy between his clinical experiences and the social determinants of health. As a practicing pediatrician, Brett's research considers the physician as medical citizen, with an intention to re-position medical expertise to ensure the equitable delivery of health care, regardless of circumstance. For example, it is simple for a doctor to prescribe asthma medicine for a wheezing child, but medical training doesn't equip doctors with the skills to examine the social, cultural, economic and other reasons why some children and families struggle to manage this condition. Through his research, Brett hopes to reimagine physician training with the goal of realizing the Canada Health Act’s inherent promise of health equity. Brett is a recipient of a 2017 Pierre Elliott Trudeau doctoral scholarship.

Brett Schrewe, Pierre Elliott Trudeau Foundation scholar
 
Claudia Ruitenberg
Edwardsville
United States
 

Research Topic

Turning Canadian Medical Education Inside Out: Medical Citizenship In The Service Of Health Equity

Research Description

The Canada Health Act is dedicated to “maintaining and improving the health and well-being of Canadians”. Yet ours is a diverse country in which people live in a wide spectrum of socioeconomic conditions; these underappreciated contextual factors may significantly impact individuals’ health. Although medical education programs include content to help professionals-in-training address these factors, they remain secondary pedagogical pursuits with their transformative potential largely untapped. To invert this relationship, my research looks to elaborate a novel disposition of physician as medical citizen. I am using genealogy to consider how social accountability, medical professionalism, and health advocacy discourses emerged in medical education, how we might incorporate them as the basis of this disposition and how an overemphasis upon physicians as medical experts might fragment their promising effects. As such, I intend to re-position medical expertise to ensure that health care is equitably delivered to all, irrespective of the circumstances of each.

What aspect of your graduate program do you enjoy the most or are looking forward to with the greatest curiosity?

Honestly, it was - and continues to be - the ability to have dedicated space to read, to think, to write, to struggle with ideas, and to try to add another pebble to that long path of knowledge to which UBC continues to contribute.

What was the best surprise about UBC or life in Vancouver?

For a city that continues to grow in global popularity - with which has come crowding and congestion, it remains happily easy to get out of the built environment and into the natural world. Doing so is a reminder of why Musqueam, Squamish and Tsleil-Watuth peoples made here home before any of us from settler backgrounds came, and a reminder that the success of this city and this university is contingent on taking care of the surroundings that sustain them.

Why did you decide to study at UBC?

Well, the short answer - as it often is - was the people. The longer answer is that I came to UBC almost seven years ago from my adopted home of Montréal, drawn west to undertake a clinical educator fellowship at the Centre for Health Education Scholarship and an MA in Interdisciplinary Studies. While I had planned to return to McGill to complete my pediatrics residency, I ended up staying at UBC for my final year of residency and then started doing locum pediatrics work. CHES provided me an academic home throughout this time and into my first few years of practice, helping me carve out an identity in the health professions education community. Ultimately, I decided it was time to pull together my early years of clinical experience with my scholarly humanities lens and apply to the educational studies doctoral program. Back to the short answer! Bill McKellin, Dan Pratt, Joanna Bates, Kevin Eva, Glenn Regehr, Claudia Ruitenberg and the CHES community writ large. My pediatric program directors in Vancouver and the residents who welcomed me in my last year like I was one of their own. My pediatric program directors at the Montréal Children's Hospital, who supported me moving west: Richard Gosselin and Saleem Razack. And Mary Maguire at McGill, who really made me feel like I could be a humanities researcher.

What is it specifically, that your program offers, that attracted you?

Again, I would go back to the people. I first met my now supervisor, Claudia Ruitenberg, in my MA program as she taught the first course I took. I was astonished by her ability to make complex material approachable, to fold in any contribution or question in class with respect and engagement and her ability to ask questions with a clarity that belied the complexity behind them. I'm given to tangentiality and lots of ideas, which is all well and good, but in my supervisor I have someone who will help me develop coherence and clarity. This feels really important, especially because I think the purpose of academic life in many ways is to build bridges and offer approachable ideas to publics looking for innovation and creative thought as we all navigate this thing called life.

 

Why did you decide to pursue a graduate degree?

As a practicing consultant pediatrician, it is my pleasure and privilege to work with children and their families in some of the most vulnerable times in their lives. At the same time, I could not help but notice that my medical training, while useful for biomedical concerns, had prepared me less to engage productively with issues related to the social determinants of health. For example, it is one thing to prescribe medications for asthma but quite another to know how to deeply and usefully explore social, cultural, historical, economic and political reasons as to why certain children have suboptimal control of their symptoms and have their lives disrupted with a need for frequent hospital admissions. In recognizing how my medical training had not equipped me for the latter, I decided to explore why that was in a more systematic and intentional way rather than just off the side of my desk.

What do you see as your biggest challenge(s) in your future career?

Well, over the past few years it has become evident that I live in two different realms: one clinical/pediatric and one that is steeped in humanities and the social sciences. They have so much to say to each other, but they speak different languages and approach similar issues in pretty different ways. This of course leads to creative tension, which possesses the energy to be productive or destructive. I think a key challenge for me is to try to build links in ways that encourage the former in as many ways as possible. At the same time, there is a danger of being superficially syncretic at the expense of deeply synthetic, so it also is really important to be respectful of and knowledgable about the histories and traditions of both.

What do you like to do for fun or relaxation?

I like to think I'm pretty good at sleeping, but I haven't yet found a way to work that into a CV. Really, it doesn't take too much more than a journal, a pen, and a pretty good book to keep me happy. When it's winter, I could skate ski on Cypress until the end of time. There's something really nice about looking down on the city from the intersection of Lower Powerline and Sitzmark on a clear night that makes you feel small in a good way.

What advice do you have for new graduate students?

I'm not sure I have a ton, really. But I suppose I would say that many of us are balancing multiple lives in addition to being a graduate student - other professional identities, other occupations, family life, being a committed citizen, the list goes on - and taking care of that balance seems paramount.

 

Photo credit: Sylvain Légaré/PETF

 
 

Brett is a true interdisciplinary scholar who constantly challenges his work as a pediatrician with insights from the humanities and social sciences. Brett’s research on medical citizenship is rooted in his own struggle to make a meaningful contribution to children’s health in communities where housing, food security and other basics many Canadians take for granted may be inadequate. It is an honour to work with Brett as he pushes both his own and my thinking, and is not afraid to reconsider established approaches to medical education from the ground up. - Professor Claudia Ruitenberg